Pacific Highly Migratory Species Vessel Permit Applicati

U.S. DEPARTMENT OF COMMERCE
NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION
NATIONAL MARINE FISHERIES SERVICE
501 WEST OCEAN BLVD
SUITE 4200
Permit
LONG BEACH, CA 90802

OMB#: 0648-0204
APPROVAL EXPIRES: 04/30/2010

Application Fee: $30

Pacific Highly Migratory Species
Vessel Permit Application
SECTION 1 VESSEL INFORMATION (please print legibly or type)
USCG DOC. OR STATE REG. NO. VESSEL

VESSEL NAME

HULL IDENTIFICATION NUMBER

HOME PORT AND STATE

USCG DOCUMENTED HAIL PORT AND STATE

RADIO CALL SIGN

DOES THIS VESSEL HAVE AN OPERATIONAL VMS?

REGISTERED LENGTH (FT.)

YES_______

HOLD CAPACITY (SHORT TONS)

NO_______

REGISTERED DEPTH (FT.)

REGISTERED BREADTH (FT.)
HOLD CAPACITY (METRIC TONS)

GROSS TONS

NET TONS

HOLD CAPACITY (CUBIC METERS)

PROPULSION TYPE

REFRIGERATION TYPE

HORSEPOWER

HULL MATERIAL

YEAR BUILT

LOCATION BUILT

CREW SIZE (INCLUDING OFFICERS)

PASSENGER CAPACITY

VESSEL FLAG

PREVIOUS VESSEL NAMES

EFFECTIVE DATES

SECTION 2 SELECT THE TYPE OF GEAR TO BE AUTHORIZED BY THE HMS PERMIT
COMMERCIAL:

RECREATIONAL:

HARPOON

PURSE SEINE

TROLL/JIG

LONGLINE

DRIFT GILLNET

BAITBOAT

CHARTER VESSEL
No

SECTION 3 VESSEL OWNERSHIP INFORMATION
COMPANY NAME

DATE CORPORATION FILED EIN/SSN

BUSINESS ADDRESS
BUSINESS TELEPHONE

CITY
BUSINESS FAX

STATE
BUSINESS CELL PHONE

DUNNS NO.
ZIP

BUSINESS E-MAIL

MANAGING OWNER NAME LAST FIRST

MIDDLE

SUFFIX

DATE OF BIRTH (MONTH/DAY/YEAR)

SECOND OWNER NAME LAST

FIRST

MIDDLE

SUFFIX

DATE OF BIRTH (MONTH/DAY/YEAR)

THIRD OWNER NAME LAST

FIRST

MIDDLE

SUFFIX

DATE OF BIRTH (MONTH/DAY/YEAR)

SECTION 4 SIGNATURE (All applications must be signed and dated)
I certify that the above information is complete, true, and correct to the best of my knowledge and belief.
OWNER'S SIGNATURE:

NAME: (Print legibly or type)

DATE: